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KETUA PENGARAH KESIHATANMALAYSIA
DIRECTORGENERAL OF HEALTH MALAYSIA
KementerianKesihatanMalaysia
Aras 12, BlokE7, KompleksE
Pusat PentadbiranKeraiaanPersekutuan
62590 PUTRAJAYA
Tel. : 03-88832545
Faks : 03-8889 5542
Web : [email protected]
Ruj.Kami : (24 ) dlm.KKM-153
PCG/FP/TA(18)
Tarikh :
8Oktober2015
SEPERTI
SENARAIEDARAN
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GUIDANCEDOCUMENTON RADIOLOGICAL
EMERGENCYPREPAREDNESS
FORMEDICALPHYSICISTS
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TimbalanKetuaPengarahKesihatan(tGsihatanAwam)
TimbalanKetuaPengarahKesihatan(Penyelidikan
& SokonganTeknikal)
SENARAIEDARAN
1. PengarahKesihatanNegeriKedah
JabatanKesihatanNegeriKedah,
SimpangKuala,JalanKualaKedah.
05400Alor Setar,
KedahDarulAman.
2 . PengarahKesihatanNegeripulaupinang
JabatanKesihatan
NegeriPulaupinang,
Tingkat35 & 37, KOMTAR,
10590PulauPinang.
3 . PengarahKesihatanNegeriSetangor
JabatanKesihatanNegeriSelangor,
Tingkat9, 10 & 11,
WismaSunwaymas,
Lot 1, JalanPersiaran
Kayangan,
40100ShahAlam,
Selangor
DarulEhsan.
4 . PengarahKesihatanNegeriSembilan
JabatanKesihatan
NegeriSembitan,
JalanRasah,
70300Seremban,
NegeriSembilanDarulKhusus.
5 . PengarahKesihatanNegeriKelantan
JabatanKesihatanNegeriKelantan,
Tingkat5, WismaPersekutuan,
15590KotaBharu,
Kelantan
DarulNaim.
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6.
PengarahKesihatanNegeriJohor
JabatanKesihatanNegeriJohor,
Tingkat3 & 4, BlokB, WismaPersekutuan,
JalanAir Molek,
80590JohorBahru,
JohorDarulTakzim.
7 . PengarahKesihatanNegeriTerengganu
JabatanKesihatanNegeriTerengganu,
Tingkat5, WismaPersekutuan,
JalanSultanlsmail,
20920KualaTerenggan
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Darullman.
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PengarahKesihatanNegeriPerak
JabatanKesihatanNegeriPerak,
JalanPanglima
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30590lpoh,
PerakDarulRidzuan.
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PengarahKesihatanWP KualaLumpur
JabatanKesihatan
WP KualaLumpur,
JalanCenderasari,
50590KualaLumpur,
WilayahPersekutuan
Kualalumpur.
1 0 . PengarahKesihatanNegeriMelaka
JabatanKesihatan
NegeriMelaka,
Tingkat3, 4 dan 5, WismaPersekutuan,
JalanBusiness
City,BandarMICT,
75450Ayer Keroh,
Melaka.
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1 1 . PengarahKesihatanNegeripahang
JabatanKesihatanNegeriPahang,
JalanlM 4, BandarInderaMahkota,
25582Kuantan,
PahangDarulMakmur.
12. PengarahKesihatanNegeriSarawak
JabatanKesihatanNegeriSarawak,
JalanDiplomatik,
Off JalanBako,
93050Kuching,
Sarawak.
13. PengarahKesihatanNegeriSabah
JabatanKesihatanNegeriSabah,
Tingkat3, RumahPersekutuan,
JalanMatSalleh,
88590KotaKinabalu,
Sabah.
KEMENTERIAN KESIHATAN MALAYSIA
Guidance Document on Radiological Emergency Preparedness for
Medical Physicists
INTRODUCTION:
Ionizing radiation for medical purpose is based on the principle that it produces sufficient
benefit to offset the radiation detriment it causes to the irradiated person. The main aim is
to ensure that the magnitude of individual doses, the number of people exposed to
radiation and the likelihood that potential exposures will actually occur should all be kept
As Low As Reasonably Achievable (ALARA), economic and social factors being taken into
account. The use of ionizing radiation for medical purpose is well regulated by the existing
Atomic Energy Licensing Act 1984 (Act 304), subsidiary regulations, standards and
guidance documents.
A radiological emergency is a critical situation in which there is, or is perceived to
be, a hazard from unwarranted exposure to ionizing radiation. Radiological emergencies
include incidents involving sealed and unsealed radioactive sources, and radiation
generators. Radiation accidents may cause health effects if the radiation dose is above the
threshold of deterministic effect. This may cause injuries and eventual death. There is also
a risk of stochastic effects from radiation exposure which may cause cancer and severe
hereditary effects. In any emergency immediate steps must be taken to minimize the
radiological risk to the patient, worker and public.
In a hospital environment the medical physicist is the Radiation Protection Officer
(RPO) and he is part of the radiological emergency response team (ERT) that handles all
such emergencies. The RPO is responsible for overall radiation safety and ensures that
radiation exposure is kept to a minimal acceptable level.
BACKGROUND:
The use of radiation for medical purpose is increasing at an unprecedented rate in the
fields of diagnostic radiology, radiotherapy and nuclear medicine. There are well
established protocols on the safe handling and usage of radiation in the medical field.
However, there is a need to address radiological emergencies in the rare event it occurs.
The effect of any radiation incident in a medical environment will mainly cause deleterious
effects to the patient, worker and public.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
1
The draft guidance document, “Medical Response for Radiation Emergency” has
already been prepared and is well established in Hospital Kuala Lumpur. However, there is
a need to develop specific guidance documents for medical physicists to increase the
awareness of the concept of Radiological Emergency Preparedness and to improve their
capability and competency to handle such situations. There is a need to provide intensive
training to the clinical medical physicists and the state health physicists so that they will
possess the ability to respond to any radiological emergency. It is also important that they
are supplied with the essential equipment and infrastructure related to radiation
protection. Henceforth, in this document, the term medical physicist will generally refer to
both the clinical medical physicist and state health physicist except in certain specific
circumstances.
OBJECTIVES:
The purpose of this guidance document is to introduce medical physicists to the
responsibilities involved in dealing with emergency preparedness and to guide them in
developing the necessary plans to establish the procedures that have to be taken in the
event of a radiological emergency within medical facilities. It will also assist as a generic
document to provide capacity building for medical physicists to assess and handle any
unexpected radiation emergencies.
SCOPE:
This guidance document will be the key document for medical physicists to understand the
concept of radiological emergency preparedness and the overall response plan within the
medical facilities. This shall improve the coordination and communication among the
Emergency Response Team (ERT) in the hospital.
This document should be used in conjunction with the overall national plan for
radiological emergency preparedness in the country. The contents and material in this
guidance document may need to be adapted and revised to take into account the
possibility of any varying situations that may occur in the future and to suit the local
conditions of the medical facilities where it will be used.
ACKNOWLEDGEMENT:
The following guidelines were developed by the Medical Physics Unit, State Health
Physicists, Hospital Medical Physicists and the Radiation Safety Section, Engineering
Services Division, Ministry of Health Malaysia (MOH).
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
2
1.0
Basic Concepts of Radiological Emergencies
1.1
Types of Emergency
The methods for developing the capability to respond to a nuclear or radiological
emergency differ depending on the characteristics of the emergency. Consequently,
it is convenient to divide the guidance for emergency preparedness and response
into two classes:
(a) Nuclear emergencies are normally regarded as threat category I, II or III and
are dependent on whether they are on-site or off-site threats and may occur
at:
i.
ii.
iii.
iv.
v.
vi.
Large irradiation facilities (e.g. industrial irradiators);
Nuclear reactors (research reactors, ship reactors and power reactors);
Storage facilities for large quantities of spent fuel or liquid or
gaseousradioactive material;
Fuel cycle facilities (e.g. fuel processing plants);
Industrial
facilities
(e.g.
facilities
for
manufacturing
radiopharmaceuticals);
Research or medical facilities with large fixed sources (e.g. teletherapy
and blood irradiator facilities).
(b) The radiological emergencies categorized in threat category IV include:
i.
ii.
iii.
iv.
v.
vi.
Uncontrolled (abandoned, lost, stolen or found) hazardous radioactive
sources;
Misuse of industrial and medical radioactive sources;
Public exposures and contamination from unknown origins;
Serious overexposures;
Malicious threats and/or acts;
Radiation transport emergencies.
In any event of a radiation emergency, the medical response will depend on
whether there has been exposure to external sources of radiation or contamination
with radioactive material; the number of victims and the severity of the injuries. The
usual principles of medical care apply at the scene of the emergency as at a
hospital, but the details and type of radiation emergencies may differ.
In a medical radiation incident, both workers and members of the public may
be exposed to ionizing radiation from:
i.
ii.
iii.
iv.
Unshielded or shielded source(s);
Radioactive sources (e.g. radionuclides) deposited on the ground or
other surfaces;
Radioactive sources (e.g. radionuclides) contaminating the body,
clothing or possessions, and
Inhalation or ingestion of radioactive substances as a result of direct
atmospheric or environmental contamination or, subsequently, by
radioactive material in water or food.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
3
1.2
Radiation Induced Health Effects
The important aspects of radiation induced health effects that may result from a
nuclear or radiological emergency are as follows:
1.2.1 Deterministic effects
One of the primary objectives of the response to an emergency is to prevent the
occurrence of deterministic effects. A deterministic effect is one where a threshold
level of radiation dose exists, below which there is no effect and above which the
severity of the effect increases with the dose received. The threshold differs for
different organs and for different effects. A deterministic effect is described as
‘severe’ if it is fatal or life threatening or results in a permanent injury that reduces
quality of life. The thresholds for severe deterministic effects are one or more Grays
(Gy) from radiation at high dose rates (thousands to millions of times the normal
radiation doses due to background levels of radiation) delivered over a short period
of time. Keeping the doses below these thresholds will prevent deterministic effects.
Severe deterministic effects have occurred among workers and responders in
emergencies at facilities in threat categories I, II and III. Severe deterministic effects
could also result from a site owing to release of large amounts of radioactive material
from facilities in threat category I. This threat is most probably limited to large
reactors and facilities where there are huge quantities of volatile radioactive material,
such as facilities for reprocessing fuel waste.
1.2.2 Stochastic effects
The probability for the occurrence of a stochastic effect from ionizing radiation,
increases with accumulative dose, and the severity of the effect (if it occurs) is
independent of dose. Stochastic effects are assumed to occur without a threshold
level of dose and they include cancers (e.g. thyroid cancer and leukaemia) and
hereditary effects.
One of the important goals of radiation emergency preparedness is to
prevent, to the extent practicable, the occurrence of stochastic effects and its
associated risks. In fact, some actions taken to reduce the risk of stochastic effects
(e.g. relocation from an area with insignificant levels of contamination) may do more
harm than good. The difficulty lies in determining what is practicable and reasonable.
To address this issue, international standards provide generic intervention and action
levels at which various protective measures would be justified on radiation protection
grounds. Taking protective action at levels significantly below these levels could do
more harm than good.
1.2.3 Special Concern
One special concern is radiation exposure of the embryo or foetus (exposure in
utero). The health effects of radiation exposure in utero may include both
deterministic effects (e.g. a reduction in average intelligence quotient among an
exposed group) and stochastic effects expressed in the child after birth (e.g.
radiation induced cancers). As with the general population, only the exposure of a
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
4
large number of pregnant women to doses many times those due to normal
background levels of radiation could possibly give rise to a detectable increase in
stochastic effects among children exposed in utero. During the period of 8–25 weeks
after conception, foetal doses in excess of about 100 mGy may result in a verifiable
decrease of intelligence quotient. This would correspond to dose rates a thousand or
more times those due to normal background levels. However, doses sufficient to
result in deterministic effects in a child born following in utero exposure, as a
consequence of a nuclear or radiological emergency, have not been reported.
The medical response team must be prepared and trained to adequately treat
injuries caused and complicated by ionizing radiation exposure and radioactive
contamination. There should be well established and designated hospitals that have
medical professionals who have been trained and are experienced in dealing with
radiation injuries. Efficient and fast medical response is necessary in any medical
radiation emergency. Nuclear detonation and other high-dose radiation situations are
the most critical (but less likely) events as they result in acute high-dose radiation.
Acute high-dose radiation occurs in three principal situations*:
i.
A nuclear detonation which produces extremely high dose rates from
radiation during the initial 60 seconds (prompt radiation) and then from
the fission products in the fallout area near ground zero.
ii.
A nuclear reaction which results if high-grade nuclear material were
allowed to form a critical mass (“criticality”) and release large amounts
of gamma and neutron radiation without a nuclear explosion.
iii.
A radioactive release from a radiation dispersal device (RDD) made
from highly radioactive material such as cobalt-60 which can result in a
dose sufficient to cause acute radiation injury.
_______________
*
Studies on adverse consequences relating to the Chernobyl accident have been performed in those areas close to
the plant where the doses were highest. “So far, no increase in birth defects, congenital malformations, stillbirths,
or premature births could be linked to radiation exposures caused by the [Chernobyl] accident”
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
5
2.0
Medical Response Plan
...
Medical managing of an emergency situation is generally divided into medical care
on-site (more often for workers) and medical care off-site (for workers and for
affected population). There should be a well-established system for medical
assistance and response for radiological emergencies in the MOH under the control
of the Public Health Division and Radiation Safety Section.
The basic principles of the medical handling of exposed persons are based, to
a large extent, on the techniques used for handling other types of accidents, taking
into account the possible effects of radiation and contamination to health. Exposed
persons with high levels of external dose will be unusual and more often than not will
be among the employees or other professionals. In the case of a lost or stolen
source, restricted groups of the general public may get doses that can lead to
deterministic health effects. Such a situation needs specialised medical care and
palliative treatment for the early effects of acute radiation.
In the event of internal exposure, especially by long-lived radionuclides,
decorporation might be considered, even if the dose is lower than the threshold for
deterministic health effects.
In the planning stage of the medical response plan the following lists should be
prepared:
i.
ii.
iii.
iv.
v.
vi.
List of medical facilities at the local, regional, and national levels;
List of specialized medical facilities in other nearby countries;
List of medical and support staff with telephone numbers and
addresses in each respective location;
List of specialised medical centres for treating patients with radiation
induced skin lesions or immunosuppression;
List of supplies and articles needed for emergency response, and
agreements with ambulance transport services where necessary;
List of radiation monitoring and medical physics related equipment.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
6
3.0
Medical Response Organization in Radiation Emergencies
A. Offsite
NOTIFICATION
PUBLIC HEALTH
DIVISION
MEDICAL RESPONSE
INITIATOR
HEALTH PHYSICIST/
MEDICAL PHYSICIST
(Radiation Protection Officer)
FIRST RESPONDER
AMBULATORY
SERVICE
B.
TRIAGE TEAM
RADIOLOGICAL
ASSESSOR
DECONTAMINATION
TEAM
Within Hospital Premises
EMERGENCY MEDICAL MANAGER
 Emergency Department Hospital
BIOASSAY TEAM
RADIOPATHOLOGY
TEAM
EMERGENCY RESPONSE
TEAM
BIODOSIMETRY TEAM
REFERRAL
HOSPITAL
Medical Specialist
Appropriate Service
(Specialized Medical
Team)
DOSIMETRY TEAM
- Involvement of Medical Physicist
Figure 1: Medical response organization in the event of a radiation emergency.
According to the Prime Minister’s Directive 20 of the National Security Council, the
leading technical agency for any radiation emergency will be the Atomic Energy
Licensing Board (AELB). The MOH will be responsible for providing medical care to
the victims while the control of environmental spread of radioactive substances,
assessment of its impact on the environment, food and water supplies, properties and
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
7
the initiation of protective measures for these items will be the responsibility of the
AELB.
3.1
Medical Response Initiator
The Medical Response Initiator is responsible for obtaining basic information
characterizing the emergency and notifying the appropriate level of response. A
Medical Response Initiator is the person who initiates the formal medical emergency
response after notification of a real or suspected radiation emergency at the hospital.
At the hospital level, the Medical Response Initiator should be the Emergency
Medical Manager, who will notify the head of the organization where he/she is
working.
In the case of public health response initiation, it will be done by the Public
Health Division of the state or at national level.
3.2
First Responder
The First Responder is the first person or team to arrive at the scene of an accident
with an official role to play in the accident response.
At a medical facility where radioactive sources, radioactive material, or
radiation generators are used, the First Responder is the Radiation Protection Officer
(RPO). The RPO will work closely together with the ERT to help control the
emergency situation.
The RPO must have available the necessary radiation detection equipment
and dosimeters. Suitable generic precautions must be adopted by the RPO to
protect the ERT and other people present at the event from radiological hazards.
The RPO should be able to assess the level of the radiation emergency and assist
with the radiological aspects of the response.
3.3
Emergency Response Team
The ERT is the specialized medical team who is responsible for providing first aid to
casualties. Members of the team should have knowledge of emergency medicine,
the basic biological effects of ionizing radiation, and radiation protection. The role of
ERT may be performed by qualified paramedical personnel. The most important is
that all victims should be medically stabilized from any possible traumatic injuries
before radiation injuries are considered and transferred to designated hospitals.
3.4
Emergency Medical Manager
The Emergency Medical Manager is a specialist (Head of Emergency Department)
working in the hospital. He is responsible for managing the actions of the Hospital
Emergency Department Response Team, the Medical Specialist of the appropriate
service, the Medical Physicist, and the Radiation Protection Team. They will respond
to the casualties and manage the implementation of the decision to send the patient
to the referral/designated hospital.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
8
3.5
Ambulatory Emergency Services
The Ambulatory Service Team needs to be trained in contamination control
procedures prior to transferring the radiation casualties from the ambulance to the
Emergency Department of the hospital.
3.6
Hospital Emergency Response Team
The Hospital Emergency Department Response Team is a group of specialists and
trained support staff from the hospital. As soon as the casualties arrive at the
hospital, this team will be notified to initiate the necessary action. This team should
preferably comprise a Coordinator, Emergency Physician, Triage Officer, Medical
Physicist, Nurse, Technical Recorder, Public Information Officer, Security Personnel,
Laboratory Technician, and Maintenance Personnel.
The Hospital Emergency Department Response Team is in charge of
accepting the injured person into the specially prepared reception area, assessing
the patient’s medical condition and providing the necessary treatment. The Physician
will make a decision on whether to retain the patient in the hospital or send the
patient after clinical stabilization to the Referral Hospital directly. The Radiation
Protection Team will work in cooperation with the Hospital Emergency Department
Response Team.
The Emergency Medical Manager will be the main coordinator for the ERT. In
some cases, the Hospital Emergency Department Response Team can have fewer
members as long as all responsibilities are covered. Each member of the team
should be familiar with the emergency plan of the hospital and should have been
appropriately trained to deal with radiation emergencies.
3.7
Medical Specialist of Appropriate Service (Specialized Medical Team)
The medical specialist team should have the services of at least a Traumatologist,
Surgeon, Haematologist, Pathologist, Pharmacist and Medical Lab Technologist.
They are responsible for providing the required treatment for the patient, taking into
account possible external or internal contamination. They need to follow the
established protocols and procedures of the hospital plan for medical response to
radiation emergencies in dealing with injured patients. The Medical Specialist of the
appropriate service is responsible for decisions about transferring the patient to a
Referral Hospital after clinical stabilization. All these necessary actions will be
coordinated by the Emergency Medical Manager.
3.8
Referral/ Designated Hospital
The referral/ designated hospital is a dedicated hospital with staff qualified in dealing
with patients having radiation induced injuries. This hospital is responsible for
providing the patient with the necessary treatment.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
9
3.9
Public Health Division
The responsibility of the Public Health Division in a radiation emergency is to advise
the public about possible threats and initiate the response public communication
3.10
Radiological Assessor
The Radiological Assessor may be alone or part of a team and is responsible,
among other tasks, for surveys, contamination control, and arranging
decontamination operations.
This position will normally be held by the RPO who will assess the radiological
hazards, provide radiation protection for ERT and other involved personnel.
3.11
Medical Physicist
The Medical Physicist who has been specially trained for emergency medical
response will be the ‘Radiological Assessor’ at the hospital level. They have
knowledge and experience in dose assessment, radiological survey, rapid screening
of contamination, and decontamination of the patients.
They will supervise and direct external contamination monitoring in the
reception area of the Hospital Emergency Department, in the appropriate service of
the hospital and may assist in decontamination of external contamination under the
supervision of a medical specialist. The Medical Physicist is usually a member of the
Dosimetry Team.
Medical Physicists working in a clinical setting will have a number of key roles
in the event of a nuclear or radiological emergency, such as a terrorist attack
involving a radiological dispersal device or an improvised nuclear device. Their first
responsibility, of course, is to assist hospital administrators and facility managers in
developing radiological emergency response plans for their facilities and train staff
prior to an emergency. During a hospital's response to a nuclear or radiological
emergency, the Medical Physicist is responsible for:
i.
ii.
iii.
iv.
v.
vi.
Evaluating the level of radiological contamination in or on incoming
victims;
Helping the medical staff evaluate and understand the significance to
patient and staff of the levels of radioactivity with which they are
dealing;
Orienting responding medical staff with principles of dealing with
radioactive contaminants;
Providing guidance to staff on decontamination of patients, facilities,
and the vehicles in which patients were transported; and
Assisting the medical health authorities in monitoring people who are
not injured but who have been or are concerned that they may have
been exposed to radioactive materials or radiation as a result of the
incident.
Medical Physicist may also be called upon to communicate with staff
and the patients on radiological issues related to the event.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
10
The clinical Medical Physicist will also collaborate with the State Health
Physicist on mutual matters pertaining to radiation emergency preparedness. The
main roles of State Health Physicist during Radiological Emergency preparedness
are as stated below:
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
3.12
Assisting the Public Health Division to initiate Radiological Emergency
response.
Collaborate and provide technical support for hospital medical physicist
during radiological emergencies.
In case of industrial radiation casualties being brought to the hospital,
the health physicist will provide the list of industrial radioactive material
to the medical physicist in the hospital.
To provide general information on radiation effects to the psychological
support team when they deal with the public during an emergency.
Assisting in managing radiation consequences of such emergencies
Ensuring that the necessary radiation equipment is available at local
and regional levels.
Assisting the hospital in getting information on the availability
referral/designated hospital within the closest proximity area.
To have continuous collaboration with the medical physicist to ensure
that the necessary staff are well trained in radiological emergency
preparedness.
Having periodical table top exercises on the spectrum of possible
emergencies.
Decontamination Team
The Decontamination Team conducts personal and equipment contamination
monitoring at the scene of an emergency within the medical facility. This team will
assist the emergency medical response personnel with personal monitoring of the
injured people and prevention of the spread of contamination.
Decontamination procedures are recommended after the victims have been
treated for their injuries. However simple procedure of removal external clothing can
be done for non-seriously injured victims.
Team members need to be skilled in the use of radiation monitors to assess
contamination of the skin and clothing, to prevent the spread of contamination and to
monitor the efficiency of decontamination procedures. They have to be skilled in the
safe removal of clothing as well as thyroid measurement (screening). The
Decontamination Team acts in co-operation with the Radiological Assessor.
3.13
Triage Team
Triage for a limited number of victims is usually done by the ERT.
3.14
Bioassay Team
The Bioassay Team, is a specialized team with expertise in the following: in-vitro
and in-vivo bioassay; personnel internal contamination monitoring techniques;
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
11
interpretation of bioassay data, biokinetic modelling from individual retention data,
ICRP biokinetic models, individual dose assessment methodologies using bioassay
data; and radiation protection.
The Bioassay Team of the hospital needs to be able to: identify and determine
levels of specific radionuclide using in-vivo bioassay techniques (whole body and
organ counting and external counting at wound sites); identify and determine levels
of specific radionuclide in body excreta and in other biological materials such as
nasal swabs, hair, blood; interpret the data in terms of committed effective dose,
using appropriate models such as those of the IAEA or the ICRP, or individual
retention functions; and to interpret data during decorporation treatment, evaluate its
efficiency, and assess committed doses taking treatment into consideration.
The Bioassay Team works in co-operation with the Hospital Emergency
Department Response Team and the Medical Specialist of the appropriate service.
The work of the Bioassay Team is coordinated by the Emergency Medical Manager.
3.15
Radiopathology Team
The Radiopathology Team is a specialized team with expertise in radiopathology and
basic radiation protection. The Radiopathology Team of the hospital should be able
to obtain the appropriate tissue samples through biopsy or autopsy procedures;
prepare samples for histopathological analysis; and conduct the evaluation of the
samples.
The Radiopathology Team works in co-operation with the Hospital Emergency
Department Response Team and the Medical Specialist of the appropriate service.
The work of the Radiopathology Team is coordinated by the Emergency Medical
Manager.
3.16
Dosimetry Team
The Dosimetry Team of the hospital conducts personal and equipment
contamination monitoring at the hospital level, decontamination of the patients and
assessment of decontamination efficiency in the hospital.
The Dosimetry Team is responsible for complete dose evaluation for the
patient, taking into account data provided by the Bioassay Team, the Radiopathology
Team, the Biodosimetry Team, and relevant information on environmental
measurements. The team is also responsible for providing data on dose assessment
to the medical personnel in order to make necessary corrections in the treatment and
conclude on prognosis of the patient status and surveillance.
The Medical Physicist is a member of the Dosimetry Team. The work of the
Dosimetry Team is coordinated by the Emergency Medical Manager.
3.17
Biodosimetry Team
The Biodosimetry Team* is a specialized team with expertise in biological dosimetry,
basic radiation protection, and human radiation cytogenetics. This team will assist in
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
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patient dose assessment using specialized cytogenetic procedures. Typically, the
Biodosimetry Team is not routinely a component of most hospitals but is accessed
as a referral team from national or international resources.
The Biodosimetry Team works in co-operation with the ERT and the Medical
Specialist of the appropriate service. The work of the Biodosimetry Team is
coordinated by the Emergency Medical Manager.
* – If the hospital does not have Bioassay, Radiopathology, Biodosimetry and Dosimetry Teams the hospital
needs to obtain assistance within the country and/or request assistance at the international level through the
IAEA and/or WHO.
4.0
The Radiological Emergency Response Team
Each member of this team should be familiar with the hospital's written plan and be
required to participate in scheduled drills. More frequent drills (quarterly or semiannually) should be considered by subgroups such as decontamination, triage, or
radiological monitoring. Special training must be instituted to accommodate staff
turnover. Training should also be part of the hospital in-service program and should
include paramedics since they play an important role in assisting the emergency
department staff through notification procedures before arrival and proper transport
of radiation accident victims.
RADIOLOGICAL EMERGENCY RESPONSE TEAM
Personnel Role
Function
Team Coordinator
Leads, advises and coordinates
Emergency Physician
Diagnoses, treats, and provides emergency
medical care; can also function as team
coordinator or triage officer
Triage Officer
Performs triage
Nurse/Medical Assistant
Assists physician with medical procedures,
collection of specimens, radiological monitoring,
and decontamination; assesses patient's needs
and intervenes appropriately
Technical Recorder
Records and documents medical and radiological
data
Radiation Protection Officer/ Supervises all aspects
Medical Physicist
contamination control
Radiation Safety Personnel
of
monitoring
and
Monitors patient and area and advises on
contamination and exposure control; maintains
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survey equipment
Public Information Officer
Releases incident information to public media
Administrator
Coordinates hospital response and assures normal
hospital operations
Security Personnel
Secures the radiation emergency area and controls
crowds
Maintenance Personnel
Aids in preparation of the radiation emergency
area for contamination control
Laboratory Technician
Provides routine clinical analysis of biological
samples
5.0
Classification of Casualties Related to Radiation Emergencies
In a radiation emergency, victims may have been harmed by one or more of the
following causes: external exposure (localized, partial and whole body),
contamination (external/internal), and conventional trauma. All victims of a radiation
emergency are to be assessed considering all these causes. The four categories of
potential injury type are as follows:
5.1
Conventional Injury
Conventional injuries could arise from other hazards, such as fires or steam leaks; or
could result from mass panic actions (e.g. people running in the crowd). In malicious
acts involving radioactive material, mass conventional injury may happen because of
explosion/panic.
5.2
External Exposure
External exposure occurs when an individual is exposed to radiation from a source
outside the body. Personnel involved in the mitigation of an emergency or members
of the general public may receive external doses ranging from low to very high,
including lethal doses.
External exposure could be for the whole body, partial or localized. One of the
most frequent consequences of localized external exposure is local radiation burn to
the leg/hand of a staff from mishandling a sealed source, or to a member of the
general public who has gained possession of a lost or stolen sealed source.
5.3
Contamination
Contamination occurs when radioactive material (solid, liquid or gas) is released to
the environment. Workers, response personnel or members of the general public
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may become externally or internally contaminated following such release of
radioactive material. High levels of external contamination with beta radionuclide
could lead to severe radiation burns. High level of internal contamination could result
in lethal dose and death of the person.
5.4
Combined Injury
Combined injury is defined as conventional injury plus radiation exposure (external
exposure/contamination), e.g. trauma with contamination of a wound suffered in the
emergency.
5.5
Practical Application of Classification
These general categories could be subdivided into more specific groups for practical
reasons and application during triage, as well as for planning the medical response
and determining any special arrangements of necessary equipment and supplies.
6.0
Medical Preparedness and Response
Medical preparedness begins with awareness of where and what type of ionizing
radiation and radioactive materials are used in the country. This information data
base should include at least:
i.
ii.
iii.
iv.
v.
Locations where radiation or radioactive materials are used; Types and
activities of radioactive sources;
Types of radiation generating devices;
Information regarding the transportation of radioactive materials
through any respective area;
Spectrum of possible accidents, and
Estimation of the number of persons potentially affected in a severe
radiological accident.
This information is necessary for adequate planning of medical capabilities.
General and specialised medical centres may be needed, depending on the degree
and nature of radiation induced injuries. Specialised advice may not be routinely
available at the scene of the accident, except at medical facilities that use sources,
such as medical irradiation therapy hospitals, where there are medical professionals
who are experienced in dealing with radiation injuries or who have some knowledge
in this respect. The National Emergency Plan needs to identify organizations, plans
and procedures for providing such assistance.
The MOH is responsible for providing advice to other Ministries and
Government departments on the health implications of any exposure to radiation. It
is also responsible for ensuring that plans exist to provide treatment, monitoring and
health advice to the public and to persons who may have, or fear they may have
been contaminated or exposed to radiation.
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In general, there are three levels of response, according to the degree of
complexity, with respect to the necessary resources for assistance and the severity
of consequences:
i.
ii.
iii.
First aid provided at the scene of the accident;
Initial medical examination, detailed investigation and medical
treatment in a general hospital; and
Complete examination and treatment in a specialised medical centre
for treatment of radiation injuries.
At facilities with radioactive sources trained staff on every shift should
normally provide any first aid required. In the case of serious injury, medical
personnel from suitable off-site medical centres should be available. Medical
handling on-site is necessary to prevent traumatic injuries from threatening life and
as possible assessment of contamination and performance of limited
decontamination. If persons received high doses exceeding threshold for
deterministic effects it is recommended to transport them directly to a referral
hospital for complete medical examination, treatment and measurement of the dose.
All persons involved in a radiological accident should be carefully interviewed
to provide a detailed description of the emergency situation, positions of persons at
the scene of an accident and time spent there. This is necessary for the purpose of
dose reconstruction.
For situations involving large number of exposed persons one of the usual
procedures is triage of those affected — action to identify persons with different
levels and kinds of damage. To perform the triage the existing medical facilities may
be used effectively.
Any person who is externally contaminated or who is suspected to be
contaminated should be confined in a comfortable area to prevent the spread of
contamination. He/she should be decontaminated as soon as practicable. Priority
should go to persons who are heavily contaminated and to those who have open
wounds or contamination near the mouth and face, in order to reduce the risk of
internal contamination.
The task of medical staff at the first off-site stage should be to identify the
type, origin, severity and urgency of the cases. The basic principle is that treatment
of serious or life threatening injuries must take priority over other actions.
6.1
Staff Safety
The most significant issue in an emergency is to address the protection of the staff
members and first responders. Workers should be monitored for radiation exposure
and the risk of health effects must be kept in perspective to allow for optimal
evaluation and care of victims. Healthcare workers should adhere to appropriate
guidelines and standard precautions to avoid radiation injuries from handling
contaminated patients.
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Properly functioning radiation monitoring equipment must be immediately
available in the emergency department and the staff should be sufficiently trained to
perform basic radiation surveys. Basic radiation surveillance should focus on
identifying the presence of radiation, protecting staff and patients, and controlling the
spread of contamination.
All staff should adhere to the general radiation protection principles:
i.
ii.
iii.
Time – Minimize time spent near radioactive source
Distance – Maximize distance from source
Shielding – Place physical shields around source
Additionally, during an uncontrolled situation, providers should observe
universal precautions, including splash and water protection. Furthermore, staff
actively attending contaminated patients should wear personal monitoring devices,
such as real-time dosimeters and/or film badges, unless the level of exposure is
known to be negligible.
7.0
Classification of Radiation Injury Cases
A simple classification of the cases may be as follows:
7.1
Persons with symptoms of radiation exposure.
Patients should be transported urgently to a specialised hospital after
appropriate medical care. Experience has shown localised external exposure
often without radioactive contamination is the most common consequence of
radiological accident. In most cases the treatment can be offered in hospital
units specifically identified for this purpose as part of a medical emergency
plan.
7.2
Persons with combined injures (radiation plus conventional trauma).
Treatment of such patients has to be individualized in accordance with the
nature and grade of the combined injury. Usually combination of radiation
exposure with mechanical, thermal or chemical injuries may worsen
prognosis.
7.3
Persons with external and/or internal contamination
These individuals need to be monitored to assess the degree of
contamination if any. Decontamination facilities will be required. It is possible
that contamination alone, without physical injury or a significant dose from
external radiation, would be sufficient to cause an acute effect to the patient
but not to attendants. Decontamination is required to prevent or reduce further
exposure, to reduce the risk of inhalation or ingestion of contaminating
material, and to reduce spreading of contamination.
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7.4
Persons with potential radiation symptoms
Patients do not require immediate medical treatment but require urgent
evaluation of the levels of dose. Because of this, medical staff should have
sufficient knowledge, developed procedures, equipment and supplies to
perform the first biological, medical examinations and analysis, which are
necessary immediately after the accident.
7.5
Unexposed persons with conventional trauma
Patients should be taken to the specialised hospital where the medical
treatment can be adapted to the type of pathology.
7.6
Persons believed to be uninjured and unexposed patients are normally
sent home
Sometimes medical follow-up should be provided to ensure that the first
assessment was correct and to evaluate the dose more accurately.
8.0
Special Treatment Procedures
At all stages of medical care the treatment of highly contaminated individuals will
require special facilities or isolated facilities with the special procedures that limit the
spread of contamination and disposal of contaminated waste. For the detection of
radioactive contamination necessary equipment should be available, such as,
specialised radiation monitoring instruments, whole body counter and iodine thyroid
counter. Usually the RPO / medical physicist performs measurements. For the
purpose of dose reconstruction different instruments and methods can be used such
as Electron Paramagnetic Resonance (EPR) spectrometry and cytogenetic
dosimetry. As such, collection of various tissues (blood, hair, and teeth) and clothes
of exposed but non-contaminated persons should be organised. Provisions (plastic
bags, labels, etc.) should be made in advance.
Medical staff dealing with contaminated persons should use protective
clothing (overalls, masks, plastic gloves, overshoes as required), personal
dosimeters and should be monitored for possible contamination. Provisions for
changing clothes, necessary stocks of clothes, places for washing for staff should be
made in advance. Contaminated clothing should be carefully removed and discarded
in well-marked plastic bags. Dry decontamination using a towel may be a practical
way to decontaminate a person if access to showers is not possible. Otherwise,
contaminated individuals should shower, using mild soap as required washing off the
contamination. Harsh scrubbing is not recommended as it may injure the skin and
lead to internal contamination. If the hair is heavily contaminated, cutting it off may
be the simplest and most effective solution. Decontamination should be generally
repeated until measurements indicate background levels. Collecting contaminated
cleaning fluids would be desirable, but is often not practical.
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At the national level it is necessary to provide specialised assistance to
victims with acute radiation syndrome or serious radiological injuries of the skin. For
this purpose it is necessary to indicate beforehand highly specialised hospitals with
various departments (Haematology, Haemotherapy, Intensive Care, Plastic Surgery)
and develop agreements to treat highly exposed persons at such hospitals.
Medical staff and support personnel should be trained on the principles of
radiation protection, health consequences of the exposure and methods for dealing
with exposed and/or contaminated persons. The training should include drills and
exercises in medical response and in performing contamination monitoring,
decontamination, interviews, etc.
Management of every designated medical facility is responsible for the
following aspects:
i.
ii.
iii.
iv.
9.0
Designation and, if necessary, additional training of appropriate staff;
Development of detailed emergency plan and procedures;
Indication of space where reception and treatment can take place, and
Provision and proper maintenance of special equipment and all
necessary items.
Psychosocial Aspects of Radiation Exposure Emergencies
It is believed that radiation exposure emergencies, more so than any other
biomedical events, will result in greater emotional distress and anxiety given the
public's lack of knowledge and understanding about its consequences. Immediate
fears of exposure, radiation poisoning and contamination will likely develop into longterm anxiety and fears of cancer, fertility and possible birth defects.
Emergency scenarios such as radiation exposure disaster situation are
considered to be primarily “behavioural” emergencies where the psychological
impact far outweighs the physical or medical impact of the event. For instance in the
Tokyo subway Sarin gas attack, the psychological casualties outweighed the medical
casualties by a ratio of 4:1.
Disaster preparedness programmes have been shown to alleviate
psychological harm in affected populations. Providing psychosocial support to
disaster-affected populations has been recognized as a key strategy in reducing
adverse mental health effects of disasters.
Assessing immediate mental health needs and providing Psychological First
Aid (PFA) to survivors, as well as providing Disaster Mental Health training to
Disaster response workers have been incorporated as an essential element in the
Disaster Preparedness and Response Programmes of many countries including the
US and EU.
In responding to any radiation exposure disaster, preparedness training of
Emergency Response Teams will need to include basic skills in PFA as well as the
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usual emergency disaster response skills of administering physical aid. This skill will
assist response workers to quickly perform “Psychological Triage” on survivors
mental health needs alongside the physical health needs. However it should also be
noted that radiation exposure emergencies may cause reactions far beyond the
individuals directly affected or even beyond borders of the country affected.
PFA has been designed to reduce the initial distress caused by traumatic
events. It also help foster the survivors' short- term and long- term coping skills and
functioning by promoting adaptive skills in dealing with the emotional traumatic
effects of the radiation disaster.
Supportive interventions immediately after the disaster as part of PFA include
promoting non-intrusive human connection for survivors, providing the safety and
comfort of disaster survivors, assessing survivors' physical and mental health needs
immediately after the traumatic event, giving practical help and information (e.g.
where to get shelter etc.), assisting survivors to get in touch with support network
and agencies (e.g. Welfare Department. services), supporting disaster survivors'
efforts to cope with the event by providing information that help coping skills (e.g.
simple relaxation skills like breathing exercises), and providing the link for survivors
to be referred to other services as and when needed.
Since radiation effects are not really clearly understood by the lay public,
initial reactions such as anxiety, fear and panic among survivors will need immediate
attention and intervention. Accurate information as well as access to accurate
information are areas of concern as this will help alleviate the sense of panic and
loss of control and avoid stigmatizing influences in the community particularly in
radiation exposure emergencies where fears of contamination and long term health
effects can dominate.
Psychosocial support can also be useful in the post-disaster stage where
survivors are encouraged to return to their usual routines as far as possible.
Providing continued psychosocial support and assistance to disaster survivors postdisaster will also help in health surveillance and mitigate adverse mental health
effects in the survivor population.
Date: 8th October 2015
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GLOSSARY
Absorbed Dose
The energy imparted to matter by ionizing radiation
per unit mass of irradiated material at the place of
interest. The unit of the absorbed dose is Gray (Gy),
while the Dose Equivalent, which is the product of
absorbed dose and quality factor, is expressed in
Sievert (Sv).
Accident
Any unintended event, including operating errors,
equipment failure or other mishaps, the consequences
or potential consequences of which are not negligible
from the point of view of protection or safety.
Alpha Particle
A specific particle ejected spontaneously from the
nucleus of some radioactive elements. It is identical to
a helium nucleus, which has an atomic mass of 4 and
an electrostatic charge of 2, it has low penetrating
power and short range. The most energetic charge
alpha particle will generally fail to penetrate the skin.
The danger occurs when matters containing alphaemitting radionuclides are introduced into the lungs or
wounds.
Arrangements
(for emergency response)
The integrated set of infrastructural elements
necessary to provide the capability for performing a
specified function or task required in response to a
nuclear or radiological emergency. These elements
may
include
authorities
and
responsibilities
organization,
coordination,
personnel,
plans,
procedures, facilities, equipment or training.
Atom
The smallest particle of an element which cannot be
divided or broken up by chemical means. It consists of
a central core called the nucleus, which contains
protons and neutrons.
Dangerous Source
A source that could, if not under control, gives rise to
exposure sufficient to cause severe deterministic
effects. This categorization is used for determining the
need for emergency response arrangements and is
not to be confused with categorizations of sources for
other purposes.
Decontamination
The reduction or removal of contaminating radioactive
material from a structure, area, object or person.
Decorporation
The therapeutic removal of radioactive material that
has been absorbed by the body.
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Deterministic Effect
A health effect of radiation for which generally a
threshold level of dose exists above which the severity
of the effect is greater for a higher dose. Such an
effect is described as a ‘severe deterministic effect’ if it
is fatal or life threatening or results in a permanent
injury that reduces quality of life.
Emergency
A non-routine situation or event that necessitates
prompt actions, primarily to mitigate a hazard or
adverse consequences for human health and safety,
quality of life, property or the environment. This
includes nuclear and radiological emergencies and
conventional emergencies such as fires, release of
hazardous chemicals, storms or earthquakes. It
includes situations for which prompt action is
warranted to mitigate the effects of a perceived
hazard.
Emergency Phase
The period of time from the detection of conditions
warranting an emergency response until the
completion of all the actions taken in anticipation of or
in response to the radiological conditions expected in
the first few months of the emergency. This phase
typically ends when the situation is under control, the
off-site
radiological
conditions
have
been
characterized sufficiently well to identify where food
restrictions and temporary relocation are required, and
all required food restrictions and temporary relocations
have been implemented.
Emergency Plan
A description of the objectives, policy and concept of
operations for the response to an emergency and of
the structure, authorities and responsibilities for a
systematic, coordinated and effective response. The
emergency plan serves as the basis for the
development of other plans, procedures and
checklists.
Emergency Preparedness
The capability to take actions that will effectively
mitigate the consequences of an emergency for
human health and safety, quality of life, property and
the environment.
Emergency Procedures
A set of instructions describing in detail the actions to
be taken by response personnel in an emergency.
Emergency Response
The performance of actions to mitigate the
consequences of an emergency for human health and
safety, quality of life, property and the environment. It
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
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may also provide a basis for the resumption of normal
social and economic activity.
Emergency Worker
A worker who may be exposed in excess of
occupational dose limits while performing actions to
mitigate the consequences of an emergency for
human health and safety, quality of life, property and
the environment.
Emergency Zones
The precautionary action zone and/or the urgent
protective action planning zone.
Exposure
The act or condition of being subject to irradiation.
Exposure can be either external exposure (due to a
source outside the body) or internal exposure (due to
a source within the body).
First Responders
The first members of an emergency service to
respond at the scene of an emergency.
Incident
Any unintended event, including operation errors,
equipment failures, initiating events, accident
precursors, near misses or other mishaps, or
unauthorized act, malicious or non-malicious, the
consequences or potential consequences of which are
not negligible from the point of view of protection or
safety.
Initial Phase
The period of time from the detection of conditions
that warrant the performance of response actions that
must be taken promptly in order to be effective until
those actions have been completed. These actions
include mitigatory actions by the operator and urgent
protective actions on and off the site.
Mitigatory Action
Immediate action by the operator or other party:
1) To reduce the potential for conditions to develop
that would result in exposure or a release of
radioactive material requiring emergency actions
on or off the site; or
2) To mitigate source conditions that may result in
exposure or a release of radioactive material
requiring emergency actions on or off the site.
Notification
1) A document submitted to the regulatory body by a
legal person to notify an intention to carry out a
practice or other use of a source;
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
23
2) A report submitted promptly to a national or
international authority providing details of an
emergency or a possible emergency, for example
as required by the Convention on Early
Notification of a Nuclear Accident;
3) A set of actions taken upon detection of
emergency conditions with the purpose of alerting
all organizations with responsibility for emergency
response in the event of such conditions.
Site Area
A geographical area that contains an authorized
facility, activity or source, and within which the
management of the authorized facility or activity may
directly initiate emergency actions. This is typically the
area within the security perimeter fence or other
designated property marker. It may also be the
controlled area around a radiography source or a
cordoned off area established by first responders
around a suspected hazard.
Source
Anything that may cause radiation exposure — such
as by emitting ionizing radiation or by releasing
radioactive substances or materials — and can be
treated as a single entity for protection and safety
purposes. For example, materials emitting radon are
sources in the environment; a sterilization gamma
irradiation unit is a source for the practice of radiation
preservation of food; an x-ray unit may be a source for
the practice of radiodiagnosis; a nuclear power plant is
part of the practice of generating electricity by nuclear
fission, and may be regarded as a source (e.g. with
respect to discharges to the environment) or as a
collection of sources (e.g. for occupational radiation
protection purposes). A complex or multiple
installations situated at one location or site may, as
appropriate, be considered a single source for the
purposes of application of international safety
standards.
Special Facility
A facility for which predetermined facility specific
actions need to be taken if urgent protective actions
are ordered in its locality in the event of a nuclear or
radiological emergency. Examples include chemical
plants that cannot be evacuated until certain actions
have been taken to prevent fire or explosions and
telecommunications centres that must be staffed in
order to maintain telephone services.
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Stochastic Effect
(of radiation)
A radiation induced health effect, the probability of
occurrence of which is greater for a higher radiation
dose and the severity of which (if it occurs) is
independent of dose. Stochastic effects may be
somatic effects or hereditary effects, and generally
occur without a threshold level of dose. Examples
include various forms of cancer and leukaemia.
Urgent Protective Action
A protective action in the event of an emergency
which must be taken promptly (normally within hours)
in order to be effective, and the effectiveness of which
will be markedly reduced if it is delayed. The most
commonly considered urgent protective actions in a
nuclear or radiological emergency are evacuation,
decontamination of individuals, sheltering, respiratory
protection, iodine prophylaxis and restriction of the
consumption of potentially contaminated foodstuffs.
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APPENDIX A
Threat
Description
category
I
Facilities, such as nuclear power plants, for which on-site events
(including very low probability events) are postulated that could give rise
to severe deterministic health effects off the site, or for which such events
have occurred in similar facilities.
II
Facilities, such as some types of research reactors, for which on-site
events are postulated that could give rise to doses to people off the site
that warrant urgent protective action in accordance with international
standards, or for which such events have occurred in similar facilities.
Threat category II (as opposed to threat category I) does not include
facilities for which on-site events (including very low probability events)
are postulated that could give rise to severe deterministic health effects
off the site, or for which such events have occurred in similar facilities.
III
Facilities, such as industrial irradiation facilities, for which on-site events
are postulated that could give rise to doses that warrant or contamination
that warrants urgent protective action on the site, or for which such
events have occurred in similar facilities. Threat category III (as opposed
to threat category II) does not include facilities for which events are
postulated that could warrant urgent protective action off the site, or for
which such events have occurred in similar facilities.
IV
Activities that could give rise to a nuclear or radiological emergency that
could warrant urgent protective action in an unforeseeable location.
These include non-authorized activities such as activities relating to
dangerous sources obtained illicitly. They also include transport and
authorized activities involving mobile dangerous sources such as
industrial radiography sources, nuclear powered satellites or radiothermal
generators. Threat category IV represents the minimum level of threat,
which is assumed to apply for all States and jurisdictions.
V
Activities not normally involving sources of ionizing radiation, but which
yield products with a significant likelihood of becoming contaminated, as
a result of events at facilities in threat category I or II, including such
facilities in other States, to levels necessitating prompt restrictions on
products in accordance with international standards.
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APPENDIX B
EQUIPMENT AND SUPPLIES
This appendix presents a list of equipment and supplies recommended for
immediate medical response to radiation emergencies to be performed at prehospital and hospital levels (depending on national arrangements for distributing or
stockpiling, some of the mentioned medicine, kits of equipment and supplies could
be basic or extended).
Instrumentation
First aid kit
Set of standard surgical instruments.
Equipment for blood transfusion.
Disposable syringes.
Analgesics.
Cardiogenic drugs.
Antihypotensive or antihypertensive
drugs.
Antiemetic.
Antibiotics.
Topical antibiotic cream.
Blood cell counter.
Microscope.
Containers for collecting biological
samples.
Phlebotomy kits.
Ambubag and mask.
Defibrillator, batteries and charger.
Containers for biological sample
collection and storage.
Rehydration salts.
Radiation survey instruments
Personal protection equipment
Multipurpose gamma/beta monitor.
Alpha/beta
surface
contamination
monitor.
Area monitor protective overalls.
Check sources overshoes.
Beta/gamma surface contamination
monitor.
Reading dosimeter.
Permanent dosimeter.
General supplies decontamination kit
General supplies decontamination kit
Portable
radio
with
frequencies.
Cellular phone.
PC (notebook).
Spare batteries.
Critical spare parts.
Plastic sheets, tapes, bags.
Surgical clothing.
Sheets and blankets.
Portable stretchers.
Tags and adhesive labels.
Saturated solution of KMnO4.
adjustable
Area monitor protective overalls.
Check sources overshoes.
Cotton gloves, vinyl gloves, rubber
gloves.
5% NaHSO3.
0.2 N H2SO4.
5% sodium hypochlorite solution.
HCl solution 0.1 N.
Sterile eyewash solution.
Surgical cotton rolls.
Cotton applicators for nasal swabs.
Masking tape.
Brushes, including nail brushes.
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
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Medical information forms.
Radiation emergency patient form.
Drapes.
Waste bags.
Administrative supplies.
Cases for shipment.
Paraffin gauze dressings.
Swabs.
Nasal catheters.
Detergents.
Sterile water for wound and skin.
Decontamination indelible felt pens for
marking contaminated spots.
Torch.
Supporting documentation
Laboratory equipment
Operational manuals.
Procedure document.
Centrifuge.
Large refrigerator (for preserving
samples).
Freezer (for storing samples).
Different reagents, depending on the
type of samples and radionuclide to be
measured.
Report form for patient transportation.
List of WHO/REMPAN collaborating
centres.
List of phone numbers in the country
and procedure for resusting assistance.
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To be completed by:
Dosimetry Team
WORKSHEET 1
RECORD OF PATIENT RADIOLOGICAL
SURVEY (AT HOSPITAL)
No. _______
Surveyed by: ___________________________________________________
(Full name)
Provide to:
Performed in:
Date: ___________
Hospital Emergency Department Response Team
Health/Medical Physicist
Time: ___________
Hospital ambulance reception area
Hospital treatment area
Name of victim: ____________________________________________
Date of measurement: ______/______/______
Sex:
M
F
Time of measurement: ___________
Contamination survey
Instrument type: ___________________
Model: ___________
Background reading: ______________
Detector active surface: _____________ [cm ]
2
Remarks: Indicate readings in the lines provided in the diagram. Indicate location of the readings by arrows. Only record readings greater than
background.
Results of thyroid survey: _________________ [
]
(Count rate from neck)
[Unit]
__________________ [
]
(Background count rate)
[Unit]
__________________ [
(Count rate from thigh)
]
[Unit]
__________________ [
(Net count rate)
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
]
[Unit]
29
To be completed by:
Dosimetry Team
WORKSHEET D3
METHODS AND EFFICIENCY OF
DECONTAMINATION
Calibration coefficient: _________ [Bq/Unit of count rate]
Further evaluation at medical facility necessary:
Yes No
No. _______
Activity_____ [Bq]
Surveyor signature: ____________
Decontaminated by: _________________________________________________
(Full name)
Provide to: 

Performed in:

Date: ___________
Hospital Emergency Department Response Team
Medical Physicist Time: ___________
Hospital ambulance reception area
Hospital treatment area
Name of victim:
Sex:
M
F
Contamination survey
Instrument type: ___________________
Model: ___________
Background reading: ______________
Detector active surface: _____________ [cm2]
Method: ___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Results of decontamination:
Method used for
decontamination
Area
decontaminated
Activity before
decontamination
Activity after
decontamination
Remarks:
Signature:
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
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REFERENCES
1. NATIONAL
COUNCIL
ON
RADIATION
PROTECTION
AND
MEASUREMENTS, Management of Persons Accidentally Contaminated with
Radionuclides, Report No. 65, NCRP, Maryland (1980).
2. INTERNATIONAL ATOMIC ENERGY AGENCY, Emergency Planning and
Preparedness for Accident Involving Radioactive Materials Used in Medicine,
Industry, Research and Teaching, IAEA Safety Series No. 91, IAEA, Vienna
(1989).
3. JARRETT, Medical Management of Radiological Casualties Handbook, AFRRI,
Maryland (1999).
4. INTERNATIONAL ATOMIC ENERGY AGENCY, Generic Procedures for
Monitoring in a Nuclear or Radiological Emergency, IAEA-TECDOC-1092,
IAEA, Vienna (1999).
5. UNITED NATIONS SCIENTIFIC COMMITTEE ON THE EFFECTS OF
RADIATION, Sources and Effects of Ionizing Radiation, Report to the General
Assembly with Annexes, UNSCEAR, Vienna (2000).
6. INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION,
Pregnancy and Medical Radiation, ICRP Publication No. 84, Pergamon Press,
Oxford (2000).
7. UNITED NATIONS, Sources, Effects and Risks of Ionizing Radiation: Volume
II, Effects (Report to the General Assembly), Scientific Committee on the
Effects of Atomic Radiation (UNSCEAR), UN, New York (2000).
8. INTERNATIONAL ATOMIC ENERGY AGENCY, Method for Developing
Arrangements for Response to a Nuclear or Radiological Emergency, EPRMethod, IAEA, Vienna (2003).
9. INTERNATIONAL ATOMIC ENERGY AGENCY, Generic Procedures for
Medical Response during a Nuclear or Radiological Emergency, IAEA, Vienna
(2005).
10. INTERNATIONAL ATOMIC ENERGY AGENCY, Development of an Extended
Framework for Emergency Response Criteria, IAEA-TECDOC-1432, IAEA,
Vienna (2005).
11. INTERNATIONAL ATOMIC ENERGY AGENCY, Arrangements for
Preparedness for a Nuclear or Radiological Emergency, IAEA Safety Guide No.
GS-G-2.1, IAEA, Vienna (2007).
Guidance Document on Radiological Emergency Preparedness for Medical Physicists
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WEB RESOURCES
1. American Association of Physicists in Medicine
www.aapm.org
2. American College of Radiology
www.acr.org
3. American Medical Association (AMA)
www.ama-assn.org
4. National Security Council Directive No. 20, Policy and Mechanism of National
Disaster Management and Relief
http://www.adrc.asia/management/MYS/Directives_National_Security_Council.
html
5. Radiation Emergency Assistance Center/ Training Site (REAC/TS)
www.orau.gov/reacts
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